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PERMIT APPLICATIC <br /> BUILDII*HVIECHANICAL/ PLUMBING I SIGN PRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everette s@everettwa. ov www.everettwa. ov/ ermits <br /> p 9 I 9 p <br /> (Blue or:Black Ink:O;nl1y Please)a PROJECT SITE INFORMAT10Kz <br /> PROJECT SITE ADDRESS: 1 ,27 612-A1-40 PWG: 1.1V-4?-611 W Qr 1,ftO{ PROPERTY TAX#: DD 46;8 Pn 22 3d o Zoo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ''CONTACT=INFORMATION <br /> OWNER NAME: MA Q(O Aho 0A- C.c.s T cth2 D TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (12"7 �L oNO A1J(T <br /> CITY �V G��-li� �J so I STATE ZIP <br /> OWNER PHONE: 42.5%427_r"2.0 3 3 OWNER EMAIL: 0\51-E(2-(313 AT"/ G.Gd V . <br /> CONTRACTOR NAME: SAV'*( A5 P 00--- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ts1 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> MA2x O A-cc TU 120 CONTACT EMAIL: <br /> BUILDINGaPERMT APPLICATION <br /> Existing Use of Building: 5/t46(01:4744i( /Zgwil-n.J — Contract Price of Work:$ <br /> Proposed Use of Building: 6 46-A-6:1 Heat Source: ❑Gas Iectric DOther <br /> Building Type: CaSFR-Detached ❑SFR-Attached El Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: Mew ew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1vetpc-L1&:0 2 LAce-- CAA 11-A6 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL:PERMIT APPLICATION ;,PLUMBING PERMIT APPLICATION; <br /> Type of Project: New Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping _ Boiler Lavatory(Wash Basin) Drinking Fountain <br /> `Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER'/SUPPRESSION.SYSTEM =_ <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.lam the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> /2g(/2oVe. City of Everett Official Use Only <br /> 1PERMIT# i7 ( � <br /> "7—o c-1-10 <br /> / <br /> Owner/Authorized Agent Signature ( Date (Revised 5/20/2016) �--� <br />